Chun Shing Kwok1, Muhammad A Khan1, Sunil V Rao1, Tim Kinnaird1, Matt Sperrin1, Iain Buchan1, Mark A de Belder1, Peter F Ludman1, James Nolan1, Yoon K Loke1, Mamas A Mamas2. 1. From the Cardiovascular Institute (C.S.K., M.A.M.), Institute of Population Health (M.S., I.B.), and Farr Institute (M.S., I.B., M.A.M.), University of Manchester, Manchester, United Kingdom; Manchester Heart Centre, Central Manchester NHS Foundation Trust, Manchester, Lancashire, United Kingdom (M.A.K., M.A.M.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (S.V.R.); Department of Cardiology, University Hospital of Wales, Cardiff, Wales, United Kingdom (T.K.); Department of Cardiology, The James Cook University Hospital, Middlesbrough, North Yorkshire, United Kingdom (M.A.d.B.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom (P.F.L.); Department of Cardiology, University Hospital North Midlands, Stoke-on-Trent, Staffordshire, United Kingdom (J.N.); and Norwich Medical School, University of East Anglia, Norwich, Norfolk, United Kingdom (Y.K.L.). 2. From the Cardiovascular Institute (C.S.K., M.A.M.), Institute of Population Health (M.S., I.B.), and Farr Institute (M.S., I.B., M.A.M.), University of Manchester, Manchester, United Kingdom; Manchester Heart Centre, Central Manchester NHS Foundation Trust, Manchester, Lancashire, United Kingdom (M.A.K., M.A.M.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (S.V.R.); Department of Cardiology, University Hospital of Wales, Cardiff, Wales, United Kingdom (T.K.); Department of Cardiology, The James Cook University Hospital, Middlesbrough, North Yorkshire, United Kingdom (M.A.d.B.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom (P.F.L.); Department of Cardiology, University Hospital North Midlands, Stoke-on-Trent, Staffordshire, United Kingdom (J.N.); and Norwich Medical School, University of East Anglia, Norwich, Norfolk, United Kingdom (Y.K.L.). mamasmamas1@yahoo.co.uk.
Abstract
BACKGROUND: The prognostic impact of site-specific major bleeding complications after percutaneous coronary intervention (PCI) has yielded conflicting data. The aim of this study is to provide an overview of site-specific major bleeding events in contemporary PCI and study their impact on mortality and major adverse cardiovascular event outcomes. METHODS AND RESULTS: We conducted a meta-analysis of PCI studies that evaluated site-specific periprocedural bleeding complications and their impact on major adverse cardiovascular events and mortality outcomes. A systematic search of MEDLINE and Embase was conducted to identify relevant studies and random effects meta-analysis was used to estimate the risk of adverse outcomes with site-specific bleeding complications. Twenty-five relevant studies including 2,400,645 patients that underwent PCI were identified. Both non-access site (risk ratio [RR], 4.06; 95% confidence interval [CI], 3.21-5.14) and access site (RR, 1.71; 95% CI, 1.37-2.13) related bleeding complications were independently associated with an increased risk of periprocedural mortality. The prognostic impact of non-access site-related bleeding events on mortality related to the source of anatomic bleeding, for example, gastrointestinal RR, 2.78; 95% CI, 1.25 to 6.18; retroperitoneal RR, 5.87; 95% CI, 1.63 to 21.12; and intracranial RR, 22.71; 95% CI, 12.53 to 41.15. CONCLUSIONS: The prognostic impact of bleeding complications after PCI varies according to anatomic source and severity. Non-access site-related bleeding complications have a similar prevalence to those from the access site but are associated with a significantly worse prognosis partly related to the severity of the bleed. Clinicians should minimize the risk of major bleeding complications during PCI through judicious use of bleeding avoidance strategies irrespective of the access site used.
BACKGROUND: The prognostic impact of site-specific major bleeding complications after percutaneous coronary intervention (PCI) has yielded conflicting data. The aim of this study is to provide an overview of site-specific major bleeding events in contemporary PCI and study their impact on mortality and major adverse cardiovascular event outcomes. METHODS AND RESULTS: We conducted a meta-analysis of PCI studies that evaluated site-specific periprocedural bleeding complications and their impact on major adverse cardiovascular events and mortality outcomes. A systematic search of MEDLINE and Embase was conducted to identify relevant studies and random effects meta-analysis was used to estimate the risk of adverse outcomes with site-specific bleeding complications. Twenty-five relevant studies including 2,400,645 patients that underwent PCI were identified. Both non-access site (risk ratio [RR], 4.06; 95% confidence interval [CI], 3.21-5.14) and access site (RR, 1.71; 95% CI, 1.37-2.13) related bleeding complications were independently associated with an increased risk of periprocedural mortality. The prognostic impact of non-access site-related bleeding events on mortality related to the source of anatomic bleeding, for example, gastrointestinal RR, 2.78; 95% CI, 1.25 to 6.18; retroperitoneal RR, 5.87; 95% CI, 1.63 to 21.12; and intracranial RR, 22.71; 95% CI, 12.53 to 41.15. CONCLUSIONS: The prognostic impact of bleeding complications after PCI varies according to anatomic source and severity. Non-access site-related bleeding complications have a similar prevalence to those from the access site but are associated with a significantly worse prognosis partly related to the severity of the bleed. Clinicians should minimize the risk of major bleeding complications during PCI through judicious use of bleeding avoidance strategies irrespective of the access site used.
Authors: Peter J McCartney; Hany Eteiba; Annette M Maznyczka; Margaret McEntegart; John P Greenwood; Douglas F Muir; Saqib Chowdhary; Anthony H Gershlick; Clare Appleby; James M Cotton; Andrew Wragg; Nick Curzen; Keith G Oldroyd; Mitchell Lindsay; J Paul Rocchiccioli; Aadil Shaukat; Richard Good; Stuart Watkins; Keith Robertson; Christopher Malkin; Lynn Martin; Lynsey Gillespie; Thomas J Ford; Mark C Petrie; Peter W Macfarlane; R Campbell Tait; Paul Welsh; Naveed Sattar; Robin A Weir; Keith A Fox; Ian Ford; Alex McConnachie; Colin Berry Journal: JAMA Date: 2019-01-01 Impact factor: 56.272
Authors: Paraskevi Taxiarchi; Evangelos Kontopantelis; Tim Kinnaird; Nick Curzen; Adrian Banning; Peter Ludman; Ahmad Shoaib; Muhammad Rashid; Glen P Martin; Mamas A Mamas Journal: Int J Cardiol Date: 2020-07-30 Impact factor: 4.164